David S Mandell

David S Mandell
University of Pennsylvania | UP · Department of Psychiatry

ScD

About

358
Publications
70,935
Reads
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15,496
Citations
Introduction
The goal of my research is to improve the quality of care individuals with autism. This research is of two types. The first examines, at the state and national level, the effects of different strategies to organize, finance and deliver services on service use patterns and outcomes. The second consists of experimental studies designed to determine the best strategies to successfully implement proven-efficacious practices in community settings, especially public schools.
Additional affiliations
January 2003 - December 2012
The Children's Hospital of Philadelphia
January 2002 - December 2012
University of Pennsylvania

Publications

Publications (358)
Article
Full-text available
Autistic individuals who are also people of color or from lower socioeconomic strata are historically underrepresented in research. Lack of representation in autism research has contributed to health and healthcare disparities. Reducing these disparities will require culturally competent research that is relevant to under-resourced communities as w...
Article
Full-text available
Background Participatory design methods are a key component of designing tailored implementation strategies. These methods vary in the resources required to execute and analyze their outputs. No work to date has examined the extent to which the output obtained from different approaches to participatory design varies. Methods We concurrently used t...
Article
Full-text available
Objectives The purpose of this systematic review was to assess the current literature on mindfulness-based school interventions (MBSIs) by evaluating evidence across specific outcomes for youth. Methods We evaluated 77 studies with a total sample of 12,358 students across five continents, assessing the quality of each study through a robust coding...
Article
Opioid use disorder (OUD) is a major public health emergency in the United States. In 2020, 2.7 million individuals had an OUD. Medication for opioid use disorder is the evidence-based, standard of care for treating OUD in outpatient settings, especially buprenorphine because it is effective and has low toxicity. Buprenorphine is increasingly presc...
Article
Clinician fidelity to cognitive behavioral therapy (CBT) is an important mechanism by which desired clinical outcomes are achieved and is an indicator of care quality. Despite its importance, there are few fidelity measurement methods that are efficient and have demonstrated reliability and validity. Using a randomized trial design, we compared thr...
Article
Coaching caregivers of young children on the autism spectrum is a critical component of parent-mediated interventions. Little information is available about how providers implement parent coaching for children on the autism spectrum in publicly funded early intervention systems. This study evaluated providers’ use of parent coaching in an early int...
Chapter
Youths who are negatively affected by social determinants of health suffer adverse effects like increased risks of chronic health conditions and mental health issues. Part 2 of this series describes the adverse effects social determinants of health can have on vulnerable children around the world. Available for purchase at https://shop.aap.org/pedi...
Article
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Using the 2008–2013 Medicaid Analytic eXtract files, this retrospective cohort study was to evaluate the effect of Medicaid home and community-based services (HCBS) waiver programs on emergency department (ED) utilizations among youth with autism spectrum disorder (ASD). Our study showed that the annual ED utilization rates were 13.5% and 18.8% for...
Article
Full-text available
Data collection is an important component of evidence-based behavioral interventions for children with autism, but many one-to-one aides (i.e., behavioral support staff) do not systemically collect quantitative data that are necessary for best-practice client progress monitoring. Data collection of clients’ behaviors often involves labor-intensive...
Article
This study examined whether behavioral health service use post‐jail release was associated with reduced risk of jail reincarceration. The study sample included 20,615 individuals who had behavioral health diagnoses and were released from the Philadelphia County jail. Using administrative records of the county jail and state‐, county‐, and Medicaid‐...
Article
Background The current gold standard for measuring fidelity (specifically, adherence) to cognitive behavioral therapy (CBT) is direct observation, a costly, resource-intensive practice that is not feasible for many community organizations to implement regularly. Recent research indicates that behavioral rehearsal (i.e., role-play between clinician...
Article
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Background Advancing causal implementation theory is critical for designing tailored implementation strategies that target specific mechanisms associated with evidence-based practice (EBP) use. This study will test the generalizability of a conceptual model that integrates organizational constructs and behavioral theory to predict clinician use of...
Article
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Lay abstract: Providers' beliefs about an intervention's fit with a family can affect whether or not they use that intervention with a family. The factors that affect providers' decisions to use evidence-based practices for young autistic children have not been studied. These factors may play a role in the major differences we see in the quality o...
Article
Philadelphia, Pennsylvania, is an urban epicenter of the opioid epidemic, and inappropriate opioid prescribing remains a top concern. To help address this issue, the Philadelphia Medicaid Opioid Prescribing Initiative, a type of community quality collaborative, mailed thousands of local Medicaid providers an individualized prescribing report card i...
Article
Full-text available
Background The majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment, and the COVID-19 pandemic has exacerbated the United States (US) opioid overdose crisis. However, the pandemic has also ushered in rapid transitions to telehealth in the USA, including for substance use disorder treatment with bup...
Preprint
Full-text available
Background Participatory design methods are a key component of designing tailored implementation strategies. These methods vary in the resources required to execute and analyze their outputs. No work to date has examined the extent to which the output obtained from different approaches to participatory design varies.Methods We concurrently used two...
Article
Full-text available
Participation in research can provide direct and indirect benefit to individuals with autism spectrum disorder (ASD), their caregivers, families, and society at large. Unfortunately, individuals with high support needs, including those with intellectual disability, cognitive disability or minimal verbal ability, are often systematically excluded fr...
Article
Objective We identified common and unique barriers and facilitators of evidence-based suicide prevention practices across primary care practices with integrated behavioral health services and specialty mental health settings to identify generalizable strategies for enhancing future implementation efforts. Method Twenty-six clinicians and practice...
Article
Enrollment in Medicaid facilitates access to needed services among transition-age youth on the autism spectrum and youth with intellectual disability (ID). There are long-standing programs to ensure that individuals with ID remain enrolled as they age; similar programs for autistic youth are newer, not as widespread, and may not be as effective. We...
Article
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Purpose of Review This synthesis of recent mental health services research with autistic individuals presents significant advances, current gaps, and recommendations for improving mental healthcare for this population. Recent Findings Recent advances include improved understanding of co-occurring mental health conditions among autistic individuals...
Article
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Background Numerous studies have shown that racial/ethnic minority and under-resourced families face barriers that delay timely access to autism services. These barriers include lack of resources and information about autism, financial hardship, mistrust in the service system, cultural and language mismatch, and other factors that have yet to be id...
Article
Self-regulation is associated with many positive outcomes in children with and without autism, including increased mental health and academic achievement, and decreased problem behavior. Less is known regarding whether and how self-regulation and symptoms of mental health challenges (internalizing and externalizing problems) relate to social outcom...
Article
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Background Implementation science studies often express interest in “attitudes,” a term borrowed from psychology. In psychology, attitude research has an established methodological and theoretical base, which we briefly summarize here. We then review implementation studies designed to measure attitudes and compare their definitions and methods with...
Article
Few studies use a strengths-based perspective to identify strategies that support K-12 school transitions for historically minoritized families of children with autism spectrum disorder (ASD). In the present study, university researchers partnered with community stakeholders (e.g., disability advocates, community health organizations, etc.) in mino...
Article
Objectives Programmatic cost assessment of novel clinical interventions can inform their widespread dissemination and implementation. This study aimed to determine the programmatic costs of a telehealth Ostomy Self-Management Training (OSMT) intervention for cancer survivors using Time-Driven Activity-Based Costing (TDABC) methodology. Methods We...
Article
Objective To assess the use of Medicaid programs, including waivers, to address the needs of aging autistic individuals. Data sources We gathered data on Medicaid programs in place between 2004 and 2015 for 50 states and the District of Columbia from the Centers for Medicare and Medicaid Services website, by contacting state Medicaid administrator...
Article
Full-text available
Children with autism situated in lower income families often receive intensive educational interventions as their primary form of treatment, due to financial barriers for community interventions. However, the continuity of care can be disrupted by school transitions. The quality of social relationships during the transition to a new school among pa...
Article
Psychiatric disorders account for more years lived with disability globally than any other disease category. Currently, effective mental health treatments are variably deployed in community practice and patient outcomes in real life are less robust than they are in clinical trials. A major frontier in psychiatry is the development of strategies tha...
Article
Evidence-based practices (EBPs) are frequently proposed as an approach to close the quality chasm in behavioral health treatment, and many U.S. municipalities are investing in EBPs as a primary way to improve the quality of care delivered to individuals most in need. In this Open Forum, the authors argue that EBPs often cannot be successfully imple...
Article
Full-text available
When parents and teachers align their practices across home and school, it may optimize services for children with autism spectrum disorder (ASD). Partners in School is a multi-faceted implementation strategy designed to improve ASD services in schools. The goal is to increase parents’ and teachers’ use of evidence-based practices (EBPs) and to ali...
Article
Purpose: We developed and implemented a new model of collaborative care that includes a triage and referral management system. We present initial implementation metrics using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Methods: Primary care clinicians in 8 practices referred patients with any unmet mental...
Article
Background Substance use treatment providers have increasingly developed novel engagement and low-threshold treatment services (such as mobile treatment units) to meet the needs of people with opioid use disorder (OUD). Use of these service models has outpaced the research on their effectiveness. The current study examines the effectiveness of a mo...
Article
Background People with opioid use disorder (OUD) often have a co-occurring psychiatric disorder, which elevates the risk of morbidity and mortality. Promising evidence supports the use of collaborative care for treating people with OUD in primary care. Whether collaborative care interventions that treat both OUD and psychiatric disorders will resul...
Preprint
Full-text available
Objective: The purpose of this systematic review was to assess the current literature on mindfulness-based school interventions (MBSIs) by evaluating evidence across specific outcomes for youth. Methods: We evaluated 77 studies with a total sample of 12,358 students across five continents, assessing the quality of each study through a robust codin...
Preprint
Full-text available
Objective: The purpose of this systematic review was to assess the current literature on mindfulness-based school interventions (MBSIs) by evaluating evidence across specific outcomes for youth. Methods: We evaluated 77 studies with a total sample of 12,358 students across five continents, assessing the quality of each study through a robust codin...
Preprint
Full-text available
Objective: The purpose of this systematic review was to assess the current literature on mindfulness-based school interventions (MBSIs) by evaluating evidence across specific outcomes for youth. Methods: We evaluated 77 studies with a total sample of 12,358 students across five continents, assessing the quality of each study through a robust codin...
Article
Lay abstract: Schools play a major role in providing services to youth with autism; however, not all schools use evidence-based practices, defined as interventions that are proven to improve youth well-being through rigorous research. School culture and climate are strong predictors of whether or not a school uses evidence-based practices; however...
Article
Full-text available
Background: Persistent disparities exist in early identification of autism spectrum disorder (ASD) among children from low-income families who are racial and/or ethnic minorities and where English is not the primary language. Parental literacy and level of maternal education may contribute to disparities. The Developmental Check-In (DCI) is a visu...
Article
Medications for opioid use disorder (MOUD) are a first-line treatment for opioid use disorder, yet national surveys indicate that most substance use treatment facilities do not offer MOUD. This article presents the results of a qualitative analysis of interviews with leaders from 25 treatment organizations in Philadelphia, Pennsylvania, that invest...
Article
Partners in School is a consultation model with the goal of enhancing communication between two of the most important stakeholders in children’s lives – parents and teachers. Using a single–group pre–post design, this preliminary study examined the effect of Partners in School on parent–teacher communication outcomes and the factors associated with...
Article
Full-text available
Autistic individuals experience elevated risk for suicide ideation, attempts, and deaths. Little is known about how clinicians assess risk or intervene with suicidal autistic individuals. We surveyed 121 clinicians about use of suicide prevention practices with autistic and non-autistic clients. Clinicians reported greater self-efficacy in screenin...
Article
A history of systemic racism has led to too few Black Americans working in the sciences. Autism research is not immune to this problem, and the dearth of Black scientists and clinicians likely has contributed to health disparities among Black autistic people (Jackson & Nadine Gracia, 2014). People from underrepresented minority groups who are train...
Article
We present the case of a child of color diagnosed with autism spectrum disorder (ASD) at 67 months of age. Drawing from behavioral economics, we used this case to explore errors in decision-making by clinicians and family members and structural factors that may have delayed ASD diagnosis well beyond the national average.
Article
Full-text available
Background: Behavioral intention (which captures one's level of motivation to perform a behavior) is considered a causal and proximal mechanism influencing the use of evidence-based practice (EBP). Implementation studies have measured intention differently, and it is unclear which is most predictive. Some use items referring to "evidence-based pra...
Article
Full-text available
Background: Suicide is a global health issue. There are a number of evidence-based practices for suicide screening, assessment, and intervention that are not routinely deployed in usual care settings. The goal of this study is to develop and test implementation strategies to facilitate evidence-based suicide screening, assessment, and intervention...
Article
Objective: Youth with systemic lupus erythematosus (SLE) experience high rates of psychiatric comorbidities, which may affect medication adherence. We examined the association between psychiatric disorders and hydroxychloroquine adherence and determined whether psychiatric treatment modifies this association. Methods: We identified incident hydr...
Article
Objectives: Guidelines recommend universal screening for developmental concerns in young children in pediatric primary care, with referral to early intervention (EI) as early as possible for children with a positive screen. However, participation in EI differs by child race, ethnicity, language, and sex. This study evaluated disparities in rates o...
Article
Full-text available
Introduction: Children with autism spectrum disorder (ASD) benefit when their caregivers can effectively advocate for appropriate services. Barriers to caregiver engagement such as provider mistrust, cultural differences, stigma, and lack of knowledge can interfere with timely service access. We describe Mind the Gap (MTG), an intervention that pr...
Article
Objectives: African American (AA) children affected by autism spectrum disorder (ASD) experience delays in diagnosis and obstacles to service access, as well as a disproportionate burden of intellectual disability (ID) as documented in surveillance data recently published by the US Centers for Disease Control and Prevention. Our objective in this...
Article
Full-text available
Background Increased availability of evidence-based practices (EBPs) is essential to alleviating the negative public health and societal effects of behavioral health problems. A major challenge to implementing and sustaining EBPs broadly is the limited and fragmented nature of available funding. Method We conducted a scoping review that assessed t...
Article
Objective To examine glucocorticoid‐sparing immunomodulatory medication use in youth with systemic lupus erythematosus (SLE) during their first year of care. Methods We conducted a retrospective cohort study using administrative claims for 2000 to 2013 from ClinformaticsTM DataMart for youth ages 10‐24 years with an incident diagnosis of SLE (≥ 3...
Article
Lay abstract: For preschool children with autism, individual (one-to-one) behavioral interventions are among the best-tested treatments. However, they are rarely used in special education preschools. We observed formally and informally delivered one-to-one behavioral interventions use by classroom staff (n = 51) in 12 classrooms across three speci...
Chapter
The Individuals with Disabilities Education Act (IDEA, 2004) and the Every Student Succeeds Act (ESSA, 2015) mandate that families participate in shared decision-making with schools. For youth who receive special education services, such as those who have ASD, having parents and teachers aligned in their practices is even more crucial. Unfortunatel...
Article
Full-text available
Objective Our study aimed to examine psychiatric diagnoses and treatment preceding a schizophrenia diagnosis in adolescents, stratified by sex and race/ethnicity.Methods Using Medicaid physical and behavioral health and pharmacy claims data, we identified 1,459 adolescents who were aged 9–17 years and diagnosed with schizophrenia between January 20...
Article
Full-text available
Lay abstract: Interventions for children with autism spectrum disorder are complex and often are not implemented successfully within schools. When new practices are introduced in schools, they often are layered on top of existing practices, with little attention paid to how introducing new practices affects the use of existing practices. This stud...
Article
Full-text available
Objectives Although the American Academy of Pediatrics recommends screening for autism spectrum disorder (ASD) for all young children, disparities in ASD diagnosis and intervention in minority children persist. One potential contributor to disparities could be whether physicians take different actions after an initial positive screen based on patie...
Article
Full-text available
Background: Implementation strategies increase the adoption of evidence-based practices, but they require resources. Although information about implementation costs is critical for decision-makers with budget constraints, cost information is not typically reported in the literature. This is at least partly due to a need for clearly defined, standa...
Article
Children with autism are at high risk for self-regulation difficulties because of language delays and emotion-regulation difficulties. In typically-developing children, language development helps promote self-regulation, and in turn, cognitive development. Little research has examined the association between self-regulation and cognitive-skill deve...
Article
Full-text available
Evidence-based practices (EBP) for children with autism are under-used in special-education schools. No research compared child-level versus teacher-level influences on EBP use, which could guide implementation strategies. We derived longitudinal profiles of EBP receipt by children (N = 234) in 69 autism-support classrooms, over an academic year. W...
Article
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This editorial provides a brief history of mental health services research over the last 30 years and how findings from large-scale studies shocked the field and led to the lines of inquiry culminating in current implementation science research. I review the manuscripts published in this special issue of Administration and Policy in Mental Health i...
Article
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Background: Parent-mediated early interventions (EI) for children with autism spectrum disorder (ASD) can result in significant improvements in children's cognitive ability, social functioning, behavior, and adaptive skills, as well as improvements in parental self-efficacy and treatment engagement. The common component to efficacious parent-media...
Article
Many children diagnosed with autism spectrum disorder who receive early intervention reap developmental benefits, but little is known about characteristics of early intervention placements in the community that optimize individual growth. The extent to which children hear and use language, in particular, may contribute significantly to developmenta...
Article
Lay abstract: Several interventions or treatment programs have been shown through research to improve social outcomes for children with autism, but they often are not used in schools. This study examined individual (school personnel) and organizational (school level) factors associated with the use of a research-informed social engagement interven...
Article
Full-text available
Background: CBT comprises many discrete components that vary in complexity, but implementation and training efforts often approach CBT as a single entity. We examined variability in clinician intentions to use different structural and interventional components of CBT for three different clinical groups: clients receiving CBT, clients with depressi...
Article
Full-text available
Background: School mental health care often is provided by teams contracted from community mental health agencies. The team members that provide this care, however, do not typically receive training in how to work effectively in a team-based context. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) provides a promis...
Article
Introduction: Individuals with serious mental illness (SMI) smoke at rates 2-3 times greater than the general population but are less likely to receive treatment. Increasing our understanding of correlates of smoking cessation behaviors in this group can guide intervention development. Methods: Baseline data from an ongoing trial involving smoke...